Evidence Against Diathermy as a Beneficial Treatment for Human Papillomavirus Infection of the Cervix

An observational study of the influence of diathermy on the rate of subsequent cytological evidence of cervical intraepithelial neoplasia and/or human papillomavirus infection among women with a histological diagnosis of cervical human papillomavirus infection is presented. After the histological diagnosis of human papillomavirus infection, 35% (23/65) of women who were not diathermied had persistence/recurrence of cytological abnormalities compared with 30% (60/203) of the women who were diathermied at the time of the biopsy. The rate ratio for further abnormality among women who did not have a diathermy relative to those who did was not significantly different at 1.25 (95% confidence interval 0.77-2.03). This study had a power of 77% to detect a true rate ratio of 2 at the 0.05 level of significance. This data does not provide strong evidence that diathermy is appropriate management for women with cervical human papillomavirus infection without evidence of dysplasia.     

绝经后女性宫颈癌前病变筛查方法的比较

目的：探讨绝经后女性宫颈细胞学与人乳头瘤病毒（HPV）检测在宫颈癌前病变筛查中的作用。方法：回顾性分析2017年10月—2018年9月于天津市第一中心医院妇科门诊因宫颈筛查异常行阴道镜下活检的113例绝经后女性,分析不同宫颈液基薄层细胞学检查（TCT）及高危型HPV（HR-HPV）结果对宫颈病变检出的情况,比较组织学高度鳞状上皮内病变（HSIL）中宫颈TCT和HPV检测的敏感度、特异度、阳性预测值和阴性预测值。结果：绝经后女性HR-HPV感染分布与宫颈病变分布差异无统计学意义（χ2=0.809,P=0.303）。细胞学高风险组中组织学CINⅡ+的检出率高于低风险组（χ2=29.018,P=0.000）;宫颈活检组织学病变程度与宫颈细胞学严重程度呈弱正相关（r=0.389,P=0.000）。免疫组织化学（免疫组化）阳性组中宫颈高级别病变分布情况高于阴性组,差异有统计学意义（P=0.000）。绝经后女性宫颈TCT和HR-HPV筛查方法的敏感度、特异度、阳性预测值和阴性预测值分别为78.38%、75.00%、60.42%、87.69%和94.59%、10.13%、33.98%、80.00%。结论：宫颈TCT级别高、免疫组化阳性的绝经后女性有宫颈高级别病变的风险,需引起临床医师的关注。     

p16与宫颈病变关系的研究进展

p16是近年发现肿瘤抑制基因,其高表达与宫颈病变关系密切,且与人乳头瘤病毒（HPV）感染呈正相关。在宫颈脱落细胞中P16蛋白的表达与HC-2检测一样能够增加细胞学诊断的敏感性。且p16较HC-2检测更能够区分ASCUS细胞中是否存在病变。在一定程度上可以代替HC-2检测．提高子宫颈鳞癌的早期诊断率,从而降低传统宫颈癌筛查法的假阳性率和假阴性率,提高筛查的灵敏度和特异度,值得推广。     

p16与宫颈病变关系的研究进展

p16是近年发现肿瘤抑制基因,其高表达与宫颈病变关系密切,且与人乳头瘤病毒(HPV)感染呈正相关.在宫颈脱落细胞中P16蛋白的表达与HC-2检测一样能够增加细胞学诊断的敏感性,且p16较HC-2检测更能够区分ASCUS细胞中是否存在病变.在一定程度上可以代替HC-2检测,提高子宫颈鳞癌的早期诊断率,从而降低传统宫颈癌筛查法的假阳性率和假阴性率,提高筛查的灵敏度和特异度,值得推广.     

肉眼观察法在宫颈癌及癌前病变筛查中的应用

目的：探讨醋酸肉眼观察（VIA）和碘染色肉眼观察（VILI）在宫颈癌及癌前病变筛查中的可行性。方法：以天津市大港区2 003例妇女为研究对象,进行癌症综合知识、危险因素的问卷调查,用VIA和 VILI行宫颈癌及其癌前病变筛查。VIA或VILI阳性者行电子阴道镜检查,阴道镜检查异常者行阴道镜下宫颈活检,病理学检查明确诊断。结果：单纯VIA阳性者257例,VIA或VILI阳性者共计265例,其中197例阴道镜检查异常,在阴道镜指导下行宫颈活检,以病理学检查结果作为诊断的金标准,宫颈上皮内瘤变（CIN）的检出率为7.04%,其中CINⅠ116例,CINⅡ14例,CINⅢ11例。结论：在资源有限、经济欠发达的地区,由经过培训的医生实施VIA或VILI做宫颈癌初筛的方案可行。     

肉眼观察法在宫颈癌及癌前病变筛查中的应用

目的：探讨醋酸肉眼观察（VIA）和碘染色肉眼观察（VILI）在宫颈癌及癌前病变筛查中的可行性。方法：以天津市大港区2003例妇女为研究对象,进行癌症综合知识、危险因素的问卷调查．用VIA和VILI行宫颈癌及其癌前病变筛查。VIA或VILI阳性者行电子阴道镜检查,阴道镜检查异常者行阴道镜下宫颈活检,病理学检查明确诊断。结果：单纯VIA阳性者257例。VIA或VILI阳性者共计265例．其中197例阴道镜检查异常,在阴道镜指导下行宫颈活检,以病理学检查结果作为诊断的金标准,宫颈上皮内瘤变（CIN）的检出率为7．04％,其中CINI116例,CINⅡ14例,CINIII11例。结论：在资源有限、经济欠发达的地区,由经过培训的医生实施VIA或VIU做宫颈癌初筛的方案可行。     

人白细胞抗原与宫颈癌及癌前病变相关研究

目前大量的研究表明,高危型人类乳头瘤病毒(high-risk human papillomavirus,HPVhr)的感染与宫颈癌的发生密切相关,同时也发现了单纯的HPV感染不足以引起宫颈癌的发生,还需要其他分子事件的共同参与;宫颈癌的发生也是一个伴有细胞基因遗传改变的多步骤、多因素的过程,而且细胞内遗传因素的改变可能具有非常重要的意义。现在对于人白细胞抗原(HLA)基因多态性与宫颈癌及癌前病变的相关性研究成为热点之一。针对HLA的功能、在宫颈癌细胞上表达异常的机制、测定和分型的方法及与宫颈癌的治疗等几方面探讨HLA与宫颈癌及癌前病变的相关性进展。     

The Efficacy and Safety of Neoadjuvant Chemotherapy in Treatment of Locally Advanced Carcinoma Cervix

Objective

A prospective cohort study in a teaching hospital to assess the efficacy and safety of neoadjuvant chemotherapy in the treatment of locally advanced carcinoma cervix.

Method

Neoadjuvant chemotherapy in the form of cisplatin 75 mg/m² and paclitaxel 135 mg/m² on day 1 and repeated at 14 days’ interval for up to a maximum of three courses.

Results

Neoadjuvant chemotherapy in cervical cancer was effective in the downstaging of the disease. Downstaging was observed in 19.23 % of patients after two cycles and in 50 % of patients after three cycle of NACT. Operability increases to 33.3 and 38.4 % after two and three cycles of NACT, respectively. Complete pathological response was observed in 37.5 % of patients after NACT. No significant adverse effect in the feasibility of surgery was observed.

Conclusion

The present study showed that neoadjuvant chemotherapy was an effective and well-tolerated mode of therapy with significantly less morbidity and mortality.     

细胞信号转导通路MEK在宫颈癌前病变和宫颈癌的表达及意义

目的：探讨宫颈癌前病变及宫颈癌组织中丝裂原激活细胞外信号调节激酶（mitogen-activated extracellular signal-regulated kinase,MEK）细胞信号转导通路表达的意义。方法：选择并收集2013年1月—2014年4月在天津市第一中心医院妇科诊治、临床病理资料完整的宫颈病变患者共92例,根据宫颈病变程度将患者分为正常组（30例）、高级别宫颈上皮内瘤样变（CIN）组（30例）和宫颈癌组（32例）。用免疫组织化学SP法检测MEK在不同组织中的表达。结果：MEK在正常组、高级别CIN组和宫颈癌组中阳性表达率分别为20.0%、56.7%和68.8%,其中宫颈癌组MEK阳性表达率最高,分别高于高级别CIN组及正常组,差异有统计学意义（P＜0.05）。高级别CIN组MEK的阳性表达率高于正常组（P=0.003）。MEK阳性表达率与患者年龄、宫颈癌病理类型、肿瘤组织分化程度、肿瘤大小及宫颈癌临床分期等因素无关（P＞0.05）。结论：MEK转导通路可能在宫颈癌及癌前病变的发生发展中有一定的作用。     

Diagnostic Laparoscopy Under Local Anesthesia for Evaluation of Infertility

Diagnostic laparoscopy is routinely performed in outpatient departments. At Stanford University's Gyn/Ob Department Clinic, this procedure is performed with the client's active cooperation by using local anesthesia. In addition to the significant benefit of decreased risk of surgical anesthesia, outpatient surgery is more convenient and more economical for the client and the facility. The laparoscopic procedure is described in detail. The facilities, nursing responsibilities, surgeon's qualifications, and criteria for patient selection are included.     

Different Detectability of High-Risk HPV in Smears from Incident and Prevalent High-Grade Squamous Intraepithelial Lesions of the Cervix

Human papillomavirus (HPV) status in cervical smears from cervical intraepithelial neoplasia (CIN) 2/3 diagnosed in 36 of 892 women with a history of normal cytology and colposcopy (incident CIN 2/3) was compared with CIN 2/3 in 40 patients with a history of abnormal cytology (prevalent CIN 2/3). In all patients cervical smears for HPV testing and cytology and two cervigrams were taken. The scrapes were collected in hybrid capture assay solution and analyzed with the hybrid capture and general primer/type-specific primer polymerase chain reaction system (GP/TS-PCR) after DNA extraction. Patients with incident and prevalent CIN 2/3 were similar with respect to age. By GP/TS-PCR carried out under suboptimal conditions due to DNA extraction, HPV DNA was detected in 69.4% (25 of 36) of smears from incident CIN 2/3 compared to 95% (38 of 40) in prevalent CIN 2/3 (P= 0.003). Using hybrid capture, smears of incident CIN 2/3 were HPV positive in 50% (18 of 36) compared to 80% (32 of 40) in prevalent CIN 2/3 (P= 0.006). High-risk HPVs were significantly less common in smears from incident CIN 2/3 compared with prevalent CIN 2/3: 36.1% vs 72.5% by GP/TS-PCR (P= 0.001) and 47.2% vs 80% by hybrid capture assay (P= 0.003), respectively. Virus load in HPV-positive smears of prevalent CIN 2/3 was significantly higher than of incident CIN 2/3 using semiquantitative PCR (P= 0.0005). Thus, high-risk HPV types were detected less frequently and in lower concentration in smears from incident CIN 2/3 than in smears from prevalent CIN 2/3.     

The Diagnostic Efficacy of Swede Score for Prediction of Pre-invasive Cervical Lesions: A Prospective Hospital-Based Study

ContextThe accuracy of colposcopy has recently been called into question particularly with regard to determining the site requiring biopsy. The technique of colposcopy is largely operator dependent, and the agreement between colposcopists is less reliable than once presumed. In an attempt to standardize colposcopy a new scoring system, the Swede score has been devised, which includes lesion size as a variable to be scored in addition to the 4 variables found in the modified Reids Colposcopic Index (RCI).AimTo assess the diagnostic accuracy of Swede score for pre-invasive cervical lesion.Setting and DesignA cross-sectional study in a tertiary care centre.MethodSwede score was calculated for assessment of pre-invasive cervical lesions on patients undergoing colposcopy who were suspected with pre-invasive cervical lesion. Cervical biopsy was taken if modified RCI ≥ 3 or Swede score ≥ 5. Histopathology report of the cervical biopsy was taken as gold standard.ResultsSwede scores of 5 or more had sensitivity, specificity, positive and negative predictive values of 94.9%, 88.4%, 75.5% and 92.9% respectively.ConclusionThe Swede score by just incorporating one additional variable that is size of the lesion, showed better correlation with histopathology.     

Coexistence of Low and High Grade Squamous Intraepithelial Lesions of the Cervix: Morphologic Progression or Multiple Papillomaviruses?

Background.The diagnosis of both low (LSIL) and high (HSIL) grade squamous intraepithelial lesions in the same cervical specimen may reflect classification variation, morphologic progressionin situ,and, conceivably, different HPV infections. We addressed these possibilities in cervical specimens previously diagnosed as containing both LSIL (condyloma/CIN1) and HSIL (CIN2/3).Methods.All cases with a histologic diagnosis of LSIL and HSIL from 1994–1996 were reviewed. On review, lesions were scored as (1) no significant variation in lesion grade (classification discrepancies) and showing a (2) one (CIN1–2) or (3) two (CIN1–3) grade shift in the same case. In cases in which a one or two grade shift was confirmed, low (CIN1) and high (CIN2–3) grade foci were microdissected and extracted DNA analyzed for HPV by PCR and RFLP analysis.Results.Of 98 cases available for review, 58 (59%) did not exhibit significant variation in grade (classification discrepancy), and 40 (41%) showed a one (25) or two (15) grade shift. Of the latter group both LSIL and HSIL foci were HPV(+) in 26 (65.0%). The same HPV was present in both LSIL and HSIL foci in 15/15 lesions with a one grade shift (CIN1–2). In contrast, a significantly higher proportion of lesions with a two grade shift (CIN1–3) contained two different HPV types (4/11 vs 0/15;P= 0.01). Combinations of HPVs in the low/high grade foci, respectively, included HPV 11/16 (1), 11/16 + 18 (1), and HPV39/16 (2).Conclusions.Lesions containing LSIL and HSIL which span two grades (CIN1 and CIN2) most likely represent morphologic progression in a single infection. Lesions containing CIN1 and CIN 3 may be attributed to both lesion progression and two coincident infections; the latter sometimes present in the same histologic section. The latter phenomenon has implications for both the diagnosis of CIN and interpretation of “morphologic progression” from very low to high grade in the same case.